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NPI Code Detail

MEDICARE: JULIA ANNE WILSON M.D

MEDICARE: JULIA ANNE WILSON M.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207P00000XEmergency Medicine Physician056787GA

General Provider Information

NPI Number : 1881644854
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIA ANNE WILSON M.D
Provider Business Mailing Address
First Line : 2100 POWELL ST
Second Line : STE 920
City : EMERYVILLE
State : CA
Zip : 94608-1826
Country : US
Telephone Number : 510-350-2777
Fax Number :
Provider Business Practice Location Address
First Line : 2801 DEKALB MEDICAL PKWY
Second Line :
City : LITHONIA
State : GA
Zip : 30058-4996
Country : US
Telephone Number : 404-501-8700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2006
Last Update Date : 11/21/2007

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